What’s Cooking Here & Why

In a rural county in northern Maine, there is a school bus driver who will not start the engine until he has greeted and made eye contact with every child on the bus.

In Philadelphia, a woman who suffered years of sexual abuse by her father learns to dance out her rage and shame in movement therapy workshops offered at her neighborhood health clinic.

And in Walla Walla, Washington, an alternative high school has seen suspensions plummet since staff started approaching kids with a new question in mind—not “What’s wrong with you?” but “What happened to you?”

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“Each carries a tender spot: something our lives forgot to give us”

—Naomi Shihab Nye, Poet

By The Numbers

The original ACE (Adverse Childhood Experiences) study, published in 1998, confirmed what physicians, psychologists, social workers, substance abuse counselors and school principals had long suspected: that abuse, neglect and trauma in early childhood have a lifelong impact on health and behavior. But the study surprised even its authors, Drs. Robert Anda and Vincent Felitti, in showing how many people—even among a mostly white, well-educated, medically insured cohort of California adults—were touched by adverse experiences.

“The most beautiful people we have known are those who have known defeat, known suffering, known struggle, known loss, and have found their way out of the depths.”

—Elisabeth Kübler-Ross, Psychiatrist & Author

The Language of ACES

What do we mean when we say adversity, toxic stress or resilience? To have a conversation that crosses disciplines—medicine, mental health, social service, juvenile justice, education—and includes everyone from health policy experts to grass-roots organizers, we need to be clear about our terms.

Collective Impact

While the term “collective impact” is not limited to the work of building resilient communities, this approach to social change, which is the influential process wherein different sectors—for example, juvenile justice, education and social services—share an agenda and goals, has been key to creating successful social change. Collective impact initiatives, unlike simple collaborations, have a “backbone organization,” shared measurement systems, continuous communication and mutually reinforcing activities. More

Adversity

Hardship, distress or suffering. In the context of ACEs, adversity refers to circumstances in a child’s life including neglect, abuse and family dysfunction. It can also refer to hardships faced by individuals and communities due to natural disaster, violence, discrimination or poverty. More

Allostasis, Allostatic Load

Allostasis refers to the way the brain and body respond to challenges or stresses: by reacting, adapting and then recovering. But if the stress is extreme, negative and unrelenting, the brain and body pay a price. That accumulated wear-and-tear, called allostatic load, can cause chemical imbalances, accelerate certain diseases, and even alter brain structures. Genetics, early brain development, the social and physicalenvironment, diet and other behaviors can all influence a person’s allostatic load.

Complex Trauma

When children are exposed to multiple traumatic events, such as ongoing physical or sexual abuse, witnessing family or community violence, or separation from family members, they may suffer complex trauma, with deep and long-lasting effects on their ability to think, learn and relate to others. Research has shown that the more ACEs a person has, the higher his or her risk for problems including addiction, chronic physical conditions, depression and anxiety, self-harming behaviors, and other psychiatric disorders.

“The greatest glory in living lies not in never falling, but in rising every time we fall.”

—Nelson Mandela

Your Body & Brain

The Centers for Disease Control and Prevention’s (CDC) Adverse Childhood Experiences Study, first published in 1998, measured 10 types of childhood trauma. Five types were the usual suspects: physical, sexual and verbal abuse and physical and emotional neglect. Five were family dysfunction: a member of the household who is addicted to alcohol or other drugs; a household member who is in prison; a household member with a mental illness; a mother who is a victim of domestic abuse; and loss of a parent due to separation or divorce. There are, of course, other types of adversity—for instance, witnessing a sibling being abused, being bullied at school, witnessing neighborhood violence, experiencing a natural disaster—but those were not measured. Some subsequent surveys have included other types of trauma.

“How wonderful it is that nobody need wait a single moment before starting to improve the world.”

—Anne Frank

Tastes of success

Nine stories of communities, both large and small, engaged in the work of preventing/treating trauma and promoting resilience, are profiled here. These stories include the inspiration, the vision, the key ingredients that are bringing forth the emerging ideas, promising approaches and flourishing models.

These stories provide specific, richly detailed examples of how different communities have approached the challenge of responding to ACEs and fostering resilience. They discuss challenges and obstacles, mis-steps and lessons learned, “aha” moments and successful outcomes. These stories will be updated as they each further their work and new community stories will be added.

Essential Ingredients

Take one suffering community, season with passionate leadership, a few “aha moments” and a scoop of flexible philanthropy. Stir in training by experts in the field. Whisk together a robust communication strategy and cross-sector collaboration. Sprinkle with compelling local data. Sample frequently; share results generously. Simmer on the front burner. See change happen.

If only there were a single, simple formula for integrating practices based on adverse childhood experiences research. But the five cities and four states highlighted in this cookbook—just a small sampling of the dozens nationwide that are using ACEs research to grow healthier—demonstrate that the process varies widely from place to place.